Annals of plastic surgery
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Annals of plastic surgery · Mar 2011
ReviewApproach to venous thromboembolism prophylaxis: are we evolving fast enough in plastic surgery?
Venous thromboembolism has become a target for research by the American Society of Plastic Surgery. The current article reviews the steps that plastic surgeons and the American Society of Plastic Surgery have taken for creating guidelines in our field. We summarized the current reported incidences of venous thromboembolism in various plastic surgical procedures, and reviewed the current efforts that the society is taking to address the burden of this deadly preventable disease.
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Annals of plastic surgery · Jan 2011
ReviewOrthoplastic classification systems: the good, the bad, and the ungainly.
Over the last few decades, there have been many important advances in the treatment of severe lower limb injuries. This article looks at a few of the more widely used classification systems and Injury Severity Scores to examine their utility in a practical setting. Gustilo and Anderson formulated their landmark classification system in 1976 (J Bone Joint Surg Am. 1976;58:453-458). ⋯ This included index bacteriology, and was weighted heavily toward the presence of vascular injury. Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score attempted to address criticized weaknesses of the Mangled Extremity Severity Score. These scores can be useful tools in the decision-making process when used cautiously, but should not be used as the principal means for reaching difficult decisions.
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Annals of plastic surgery · Jan 2011
A qualitative study of recovery from type III-B and III-C tibial fractures.
The literature has shown that long-term outcomes for both below-knee amputation and reconstruction after type III-B and III-C tibial fracture are poor. Yet, patients often report satisfaction with their treatment and outcomes. The aim of this study was to explore the relationship between patient outcomes and satisfaction after open tibial fractures via qualitative methodology. ⋯ Despite reporting marked physical and psychosocial deficits, participants relayed high satisfaction. We hypothesize that the use of adaptive coping techniques successfully reduces stress, which leads to an increase in coping self-efficacy that results in the further use of adaptive coping strategies, culminating in personal growth. This stress reduction and personal growth leads to satisfaction despite poor functional and emotional outcomes.
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Annals of plastic surgery · Jan 2011
Electrical injury: a long-term analysis with review of regional differences.
Due to its relatively small share among burn injuries, published data on electrical injuries remain scarce, and differ in patient collectives due to infrastructural differences. We have retrospectively analyzed records of 56 patients who were admitted because of electrical injury to our burn center from 1994 to 2008, compared results with the current literature, and focused our review on regional differences. Patients in our collective were predominantly young men (71%, n = 40/56) and those who resulted from work-related accidents (59%, n = 33/56). ⋯ When comparing high to low-voltage injuries, patients in the former group were significantly younger, had more operations, and required a longer length-of-stay. With respect to work-related high-voltage injuries, job-specific male-predominance explains for the demographic distribution of admissions. Low-voltage injuries continue to have low mortality rates in this part of Europe, most likely as a result of established high security standards as well as access to emergency treatment with subsequent intensive and specialist surgical care.
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Annals of plastic surgery · Dec 2010
Repair of peripheral nerve defects with epineural sheath grafts.
In this study, we investigated the potential of using a detubulized flat epineural sheath for bridging nerve gaps as an alternative to nerve autografting. Nerve gaps were created by removing a 1.2-cm segment of sciatic nerves. Later, the epineurium was incised longitudinally, and after fascicle removal, a flat rectangular epineural sheath was created. ⋯ Assessments performed at 3, 6, and 12 weeks included functional (pinprick, toe-spread), neurosensory (somatosensory-evoked potentials), and histomorphometric evaluations. The functional results of toe-spread, somatosensory-evoked potentials, and histomorphometric data revealed comparable outcomes between autograft, 2-strip, and full sheath grafts, indicating adequate nerve regeneration. Thus, the new epineural sheath graft technique introduced in this study can be considered as an alternative method to standard nerve autografting technique.